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    动脉瘤性蛛网膜下腔出血介入栓塞术后短期认知功能障碍影响因素分析

    Influencing factors analysis of short-term cognitive impairment after interventional embolization in the treatment of aneurysmal subarachnoid hemorrhage

      摘要
    • 摘要:
      目的探讨动脉瘤性蛛网膜下腔出血(aSAH)介入栓塞术后认知功能障碍发生的影响因素。
      方法选取103例采用介入栓塞治疗的aSAH病人的临床资料进行回顾性分析，使用蒙特利尔认知评估量表(MoCA)评估aSAH病人术后3个月认知功能损害情况并将其分为认知障碍组37例与认知正常组66例。检测2组病人入院24 h内血清学指标血清神经元特异性烯醇化酶(NSE)、S100钙结合蛋白β(S100β)、胱抑素C(Cys-C)、超敏C反应蛋白(hs-CRP)及同型半胱氨酸(Hcy)水平并进行比较，并采用多因素logistic回归分析探讨颅内动脉瘤介入栓塞术治疗aSAH术后3个月认知功能障碍发生的危险因素。
      结果2组aSAH病人年龄、手术距发病时间、手术持续时间、双侧A1对称发育以及新发脑梗死之间比较差异均有统计学意义(P < 0.05~P < 0.01)；而2组SAH病人性别比、烟酒史等其余一般资料比较差异均无统计学意义(P>0.05)。认知障碍组病人血清NSE、S100β、Cys-C、hs-CRP、Hcy水平均分别明显高于认知正常组，而MoCA评分明显低于认知正常组(P < 0.01)。多因素logistic回归分析结果显示手术距发病时间、手术持续时间、新发脑梗死、NSE、S100β、Cys-C、hs-CRP、Hcy为aSAH介入治疗术后3个月认知功能障碍发生的独立危险因素(P < 0.05~P < 0.01)，而存在双侧A1对称发育为aSAH术后3个月认知功能障碍发生的独立保护因素(P < 0.01)。
      结论aSAH介入栓塞术后3个月发生认知功能障碍病人的入院时血清NSE、S100β、Cys-C、hs-CRP、Hcy水平均分别明显高于认知正常病人，且手术距发病时间、手术持续时间、新发脑梗死、NSE、S100β、Cys-C、hs-CRP及Hcy为aSAH术后3个月认知功能障碍发生的独立危险因素，而存在双侧A1对称发育为aSAH术后认知功能障碍发生的独立保护因素。

       

      Abstract:
      ObjectiveTo discuss the influencing factors of cognitive impairment after interventional embolization in the treatment of aneurysmal subarachnoid hemorrhage(aSAH).
      MethodsThe clinical data of 103 patients with aSAH were selected for retrospective analysis.All patients were divided into cognitive impairment group(37 cases) and cognitive normal group(66 cases) by using Montreal cognitive assessment(MoCA) scale to evaluate postoperative cognitive impairment 3 months after operation.The serological indexesserum neuron specific enolase(NSE), S100β, cystatin C(Cys-C), hypersensitive C reactive protein(hs-CRP), homocysteine(Hcy) within 24 hours after admission were detected and compared.Multivariate logistic regression analysis was used to explore the risk factors of cognitive impairment 3 months after interventional embolization of intracranial aneurysms in patients with aSAH.
      ResultsThe age, operation time from onset, operation duration, bilateral A1 symmetrical development and new cerebral infarction in the two groups were statistically significant(P < 0.05 to P < 0.01), while sex ratio, smoking and alcohol history and other general data between the two groups was not statistically significant(P>0.05).The serum NSE, S100β, Cys-C, hs-CRP, Hcy levels of the patients in the cognitive impairment group were significantly higher than those in the cognitive normal group, while the MoCA score was significantly lower than that in the cognitive normal group(P < 0.01).Multivariate logistic regression analysis showed that the time between operation and onset, operation duration, new cerebral infarction, NSE, S100β, Cys-C, hs-CRP and Hcy were the independent risk factors of cognitive impairment after interventional embolization for aSAH(P < 0.05 to P < 0.01), while bilateral A1 symmetrical development was the independent protective factor(P < 0.01).
      ConclusionsThe serum NSE, S100β, Cys-C, hs-CRP and Hcy levels of patients with cognitive impairment after interventional embolization for aSAH are significantly higher than the patients with normal cognition, and the operation time from onset, operation duration, new cerebral infarction, NSE, S100β, Cys-C Hs-CRP, Hcy are the independent risk factors for cognitive impairment after interventional embolization for aSAH, while bilateral A1 symmetrical development is the independent protective factor.

       

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